Retention Strategies Focus on Improving Welcome for New Graduate Nurses

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New graduate nurses benefit from retention progamsNew nurses go through hell, and seasoned nurses burn out. Maybe it doesn’t have to be that way.

Nurses’ departures are very costly both monetarily and spiritually. Thus, there’s an increasing onus on nurse managers to formulate programs and policies to promote nurse retention. It costs more not to.

Cost of nurse turnover

Nurses’ departures cost $700 million a year in the United States, and 15 percent of new nurses quit during their first year.

The fatigue, stress, resentment, guilt and pace of nursing that lead to burnout all have been reported widely, often in the context of a nurse shortage that is expected to reach 260,000 by 2025, with the impending retirements of baby-boom generation nurses and the steadily increasing demand for more nurses.

Fluctuating work schedules and inadequate staffing have been cited as a chief cause of burnout, but efforts to mandate minimum staffing levels are not being backed financially and might not be a quick fix.

So it becomes all the more crucial to retain new nurses. They’re the ones who are leaving at alarming rates. They feel, with reason, they are regarded as incompetent during the first year, and they often say it makes them feel they’re not fully able to ensure patients’ safety. That can combine with heavy workloads, emotional pressure and fluctuating schedules to undermine their resolve to continue.

“Anyone newly licensed or newly employed in a nursing position, especially in a health care-related facility, generally experiences either a warm welcome or becomes bullied from the start,” said Lorraine Mercado, BS, RNC, writing on Advance Healthcare Network for Nurses.

Nurses’ departures cost $700 million a year in the United States, and 15 percent of new nurses quit during their first year.

When the fledglings arrive, they’re not likely to feel much esteem. In a survey reported by American Nurse Today, only 10 percent of nurse executives feel new graduate nurses are fully prepared to practice, and the new nurses agreed. No wonder they might not want to stay.

Therefore, in their quest to retain new nurses, nurse managers are zeroing in on how they can offer that warm welcome.

Nurse retention strategies

The American Nurse Today article said, “New nurses start to feel at home and committed to stay in an organization when they are empowered in practice, have a sense of belonging in a work group, and perceive that resources balance job stress.”

An effective way to make them feel that way, strategists maintain, “is to establish nurse residency programs that indoctrinate the student and make it possible to hire a job-ready nurse when the student does graduate.”

It creates a cycle of success. It may even pay for itself in the long run.

One hospital reported saving more than $2.7 million in three years following the initiation of a nurse residency program.

“Before long, NGNs (new graduate nurses) who commit to stay become the peer group for the next wave of new nurses, smoothing out wrinkles in the welcome mat and opening wide the door to a successful professional transition.”

Orchestrating buy-in from existing staff can be an impediment the nurse leader has to overcome. It helps if the veterans take a more respectful approach toward dealing with the newcomers, because it makes them more receptive to criticism and receptive to efforts to comfort them when outcomes are unsuccessful.

But the buy-in goes beyond that. The staff has to be willing to spend time and energy becoming a source of preceptors and mentors who truly take the fledglings under their wings.

The preceptor is the shorter-term go-to person for the newcomer during the first year or two and is ideally working the same hours. The mentor takes a less-intense but longer-term interest.

Once that framework is in place, a resident nurse program ideally helps the residents link classroom activities to clinical experiences and other hands-on learning, whether in simulated situations or for real.

  • The residents see physicians and nurses interacting up close.
  • There are often visits to other hospitals and clinics to observe differences firsthand.
  • Peer support groups are also often considered crucial.
  • So is attention from administrators, who can make a difference simply by greeting a resident by name.

The object is to make the newcomers feel like part of the team and even participants in the decision process.

As advocates for nurse residency programs, the Institute of Medicine, National Council of State Board of Nursing and the Commission on Collegiate Nursing Education support statistics that show retention rates increasingly sharply, ranging from 88 percent to 96 percent where such programs are instituted.

Some claim that the savings when a new graduate nurse does not move on can fund a large portion of a residency program.

Managing employee retention

Nurse managers who want to implement these programs might have to make the argument to their business managers in terms of management style.

One hospital reported saving more than $2.7 million in three years following the initiation of a nurse residency program.

The argument is between the more progressive but sometimes more costly upfront transformational approach, which is geared to long-range planning and striving for loftier goals, and the traditional transactional approach, which is intended primarily to make the trains run smoothly at low cost and is less concerned with care and maintenance of the facilitators.

There is ample motivation to try the transformational approach, the strategists say.

It is not uncommon for the cost of the turnover of one registered nurse to be in the area of $65,000 to $80,000, according a report on NurseTogether. And that doesn’t account for the loss of the institutional knowledge of an experienced nurse. Nor does it quantify the difference in value of the departee and the newcomer.

But ultimately, the selling point might be that transformational management will also help with the retention of veteran employees, according to a Canada study that weighed the two approaches and concluded “that a focus on leadership development among managers can decrease direct care nurse burnout and increase satisfaction.”

Of course, nurse managers are hard to retain, too. With projections estimating that 75 percent of current nurse leaders will depart their jobs by 2020, and that only one in eight current nurses want to become nurse leaders, it’s easy to see why the new leaders will need to emphasize nurse retention at every level.

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